Pediatric emergency medicine trisk 4560 4560
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decontamination and medical treatment are two separate and sequential
operations. In reality, many chemical casualties will require emergent medical
resuscitation and stabilization before undergoing thorough patient
decontamination, and immediate decontamination is a component of emergent
resuscitation.
A fundamental way in which resuscitation of a chemically contaminated victim
may differ from a victim of a non-HAZMAT scenario is that personnel garbed in
PPE functioning in the warm zone outside of the ED will be challenged to
intervene with advanced life support measures. Here, ABC support will more
likely take the form of airway maneuvers, suctioning, bag-valve-mask (BVM)
ventilation, and chest compressions rather than endotracheal intubation or
establishment of an IV line. These decisions will be influenced by the ability to
ventilate a patient with BVM as well as the specific level of training of the first
receiver. As the ABCs are being attended to in the warm zone, immediate
decontamination in the form of patient disrobing should begin. Simple disrobing
may remove as much as 90% of the contamination hazard to healthcare personnel
but does not obviate the need for more thorough decontamination. Finally, in the
warm zone prior to thorough washing/showering, patients believed to be victims
of severe nerve-agent toxicity may be treated with autoinjector-delivered IM
antidotes. Once stabilization and spot decontamination have been performed,
patients with possible liquid decontamination should undergo thorough
decontamination before entering the cold zone to receive definitive care in a clean
environment. As soon as possible, the treating clinician should conduct a
secondary assessment of the patient.
